The present disclosure relates to devices and methods for their use for delivering bioadhesives (also referred to herein as “adhesives”) to sites in a body in need of repair, such as in reattachment or reinforcement of soft tissue tears (e.g., meniscal tears), ligament and muscle reattachment to bone, sealing joint capsules, and repairing cartilage delamination. Some embodiments of the disclosure may have particular use in minimally invasive orthopedic surgery, such as in delivering adhesives to sites in confined joint spaces, such as a meniscus and other difficult to reach anatomy.
By way of non-limiting example only, certain embodiments of the device and methods relate to reattaching and/or repairing meniscal tears. For non-limiting example, meniscal tissue in the knee may develop a longitudinal, vertical lesion, sometimes referred to as a “bucket handle” lesion. It is recognized that such lesions will heal over time if the lesion is closed and stabilized. One known method for repairing a meniscus tear includes making an incision accessing the knee joint and the torn meniscus; placing a suture into an inner portion of the torn meniscus and drawing it through to the outer portion. The suturing may be repeated until the tear is closed as tightly as desired. Another procedure of closing tissue tears, such as meniscal tears, involves the use of a pair of long needles which contain a suture between them, and placing the two needles through the torn meniscus from the front of the knee joint exiting percutaneously from the posterior area of the joint.
However, the use of sutures in repairing tissue tears, such as meniscal tears, is known to have deficiencies and complications, such as when sutures and/or suture knots press or rub against adjacent tissue, causing irritation. Additionally, pathologic or otherwise compromised tissue near the tear edge(s) can experience suture drag, or “cheese wiring,” potentially reducing the efficacy of the repair.
Other meniscal repair (for example) systems use a fastener which is proposed to be inserted arthroscopically. In one system, the fastener has a shank, an enlarged head at one end of the shank, and one or more barbs at the other end and/or spaced along the length of the shank. The barbed end of the fastener is tapered to a point. The fastener is proposed to be inserted, pointed end first, into the interior region of a meniscus adjacent to a tear. Insertion of the fastener can require complicated insertion devices and methods due, for example, to the barbed nature of the fasteners. Insertion is continued until the enlarged head of the fastener engages meniscal tissue. The length of the shank is selected so that when fully inserted (i.e., when the enlarged head of the fastener engages meniscal tissue), the tapered, barbed end of the fastener penetrates the meniscal tissue on the opposite side of the meniscus tear; thus, the fully inserted fastener bridges the gap of the tear and is engaged with meniscal tissue at both sides of the tear. The barbs are purportedly intended to prevent retraction of the fastener so that the meniscal tear is permanently held in the bridged position; it is further purported that the tear will eventually fully heal as repair tissue fills in the gap between the tears edges.